With acute kidney disease (AKI) incidence as high as 18% in hospitalized patients and a gold standard for a diagnostic still out of reach, laboratorians have a unique opportunity to improve the detection of kidney injury and manage this disease in patients, Paul M. Yip, PhD, FCACB, DABCC, wrote in March’s Clinical Laboratory News.
AKI is a serious illness but can be overlooked in hospitalized patients with multiple health issues. “Pressure to make room for patients awaiting hospital beds could lead to those with elevated creatinine levels being discharged without appropriate referrals for nephrology consultations,” Yip noted.
Laboratories play a big part in helping clinicians interpret results for creatinine, a versatile biomarker that’s commonly used to diagnose AKI. Clinicians rely mainly on serum creatinine and urinary output measurements, closely following the former in most hospitalized patients to make a diagnosis, wrote Yip, a clinical biochemist at the University Health Network and an assistant professor in the Department of Laboratory Medicine and Pathobiology at the University of Toronto. Many factors can affect creatinine levels, however, such as a patient’s age, sex and muscle mass.
Yip suggested that laboratory information systems (LIS) could help facilitate the process of reviewing prior creatinine results and “take some of the guesswork out of documenting possible AKI in the patient’s chart and flagging clinically important results for action.”
Labs potentially could help patients avoid nephrotoxicity and dialysis by creating an LIS estimate and using electronic alerts (e-alert) to automatically report creatinine and AKI stage results. Clinicians through this process would then be able to immediately start a medication review and supportive measures for the patient.
Yip describes his own hospital’s experiences with an e-alert system instituted in April 2016. “While we showed that computerized alerts were effective at identifying 62% of AKI cases 1 day earlier than the recorded referral, our algorithm was not as adept at distinguishing between advanced CKD [chronic kidney disease] and AKI,” he noted. Toronto General Hospital is in the process of fine-tuning this approach.
The United Kingdom—through its Think Kidneys campaign—has been especially proactive in implementing e-alerts for AKI, although a large clinical trial conducted in the United States found that the technology had no impact on reducing dialysis measures, AKI progression, or death.
Labs should first work closely with their nephrology service to develop a computerized algorithm before instituting an AKI-related e-alert, Yip advised. Pick up the March CLN to learn more about the future of this technology and its potential to improve AKI outcomes.